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Rattlesnake Bite Tale May09
Rattlesnake Bite Tale

There is an article on the front page of the May 22, 2009 Casper Star Tribune, Wyoming's main newspaper.   The gist of the tale is a dog bitten on the nose by a rattlesnake.  It's owner sucks “venom” from the wound with his mouth, then drives the dog to a vet.   The dog receives anti-venom and survives.   The owner then develops a rapid heart rate and cold sweat, is driven to the emergency room where he is presumed to be envenomated, perhaps from the stuff he sucked into this mouth, and receives four vials of anti-venom at $3500 a vial.  

Thank goodness the fellow and his dog are fine.

The story starts with the movie tale of the boy saved from snakebite with use of a tourniquet, incision and oral suction - like the scene in True Grit where John Wayne saves Kim Darby with this technique.  Add the grandfather as the source of this advice, include the emotional hook of saving the dog’s life and you have a recipe for spreading miss-information.  

The treatment for envenomation is anti-venom.  Neutralizing venom (electrical shock, meat tenderizer, ice), preventing it’s spread through the body (constriction bands, ice) or trying to remove it (incision, suction) have not been proven by medical science to work, and some of the treatments carry the risk of harming the patient.  

These treatments may seem to work in some cases, probably because so many rattlesnake strikes don’t inject venom, or inject a small amount with only a local reaction.   Just because a patient got better doesn’t mean that anything we did changed the course of the illness.  This illusion of correlation and causation is a trap we often fall into.

While we want to do something for a snakebite victim, this is a situation where the advice “Don’t just do something, stand there” is probably wise.   First make sure no one else will be bitten,  In this case the snake was killed.  I’d likely just walk away.  If there  are signs and symptoms suggesting envenomation; fang marks, swelling, pain, bruising, weakness, sweating, chills, nausea and perhaps vomiting, you can clean the wound, splint the extremity straight, avoid elevating the extremity and avoid walking, keep yourself and the patient calm and go to the hospital.  It’s not the stuff of a dramatic movie scene or newspaper tale, but neither is most of wilderness medicine.

I’m curious about the possibility that the rescuer was envenomated by sucking the venom into his mouth.  I’m not aware of any reliable case reports on this concept.  Findley Russell M.D., PhD, a renowned snake expert, says in Snake Venom Poisoning 1983 that there is little risk of envenomation if a rescuer chooses to suck venom with their mouth.  (Suction of venom is no longer recommended of course).   I’ll look into this further, and if something comes up.  I’ll let you know.

Take care
Tod Schimelpfenig  FAWM
Curriculum Director – Wilderness Medicine Institute of NOLS
May 2009

http://www.trib.com/articles/2009/05/22/news/wyoming/4f9fffc32853b474872575be000198ee.txt

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